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Research Activities, July 2011, No. 371

In-hospital cardiopulmonary resuscitation (CPR) in actual practice is frequently suboptimal and inconsistent with published guidelines. A recent study revealed that medical residents leading cardiac arrest teams do not feel adequately trained to the task. In light of these findings, many experts have advocated for new approaches to resuscitation training, such as advanced simulation training. However, a new study by a team of researchers from the University of Chicago has found no additional benefit from adding simulation training to current CPR training methods.

The research team tested whether the addition of a 4-hour immersive simulation course to a series of lectures and weekly performance debriefing sessions would improve CPR quality during actual in-hospital resuscitation. Their study involved 32 second-year internal medicine residents with Advanced Cardiac Life Support (ACLS) training, who were randomly assigned to receive either standard resuscitation training or standard plus immersive simulation training. The simulation laboratory used a complex computerized mannequin simulator in a mock-up of a traditional hospital room. The simulation training was done in groups, with each group participating in the same four scenarios of in-hospital cardiac arrest.

There were no significant differences in objective metrics of resuscitation performance between the two groups as measured by a CPR-sensing and feedback-enabled monitor/defibrillator. These metrics included chest compression depth and rate, ventilation rate, no-flow fraction, and proportion of appropriate shocks. In addition, contrary to what was expected, the study found no incremental benefit of immersive simulation training over current training methods in confidence in performing CPR or knowledge of CPR guidelines.

There were several potential explanations for the lack of benefit: the course itself may have been inadequate; CPR quality was fairly good in the study hospital prior to the start of the study; finally, the control group physicians were much more likely to have completed ACLS certification within the 6 months immediately prior to the study period. The researchers concluded that CPR-sensing technology has the potential for use in assessing the impact of a simulation curriculum on some aspects of actual resuscitation performance. This study was supported by the Agency for Healthcare Research and Quality (HS16664).